Psychological Morbidity and Rehabilitation Status in Individuals with Limb Amputation

Background: Limb amputation is a life-altering event associated with profound physical disability, functional dependence and psychological morbidity. Depression is one of the most common and  under-recognized mental health conditions among amputees and may adversely influence rehabilitation outcomes, prosthetic adaptation and quality of life. Understanding the psychosocial and functional determinants of depression is essential for planning comprehensive amputee care.

Objectives: To assess the severity of depression among individuals with limb amputation and to examine its association with selected socio-demographic, clinical, functional  and rehabilitation-related variables.

Methods: A cross-sectional analytical study was conducted among 193 adult amputees attending a tertiary care teaching hospital. Data were collected using a pre-tested semi-structured interview schedule capturing socio-demographic details, clinical profile, and rehabilitation characteristics including prosthetic use, assistive devices, employment status, sleep satisfaction, and rehabilitation attendance. Depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). Descriptive statistics were expressed as frequencies and percentages. Associations were tested using Chi-square test/Fisher’s Exact test, with p<0.05 considered statistically significant.

Results: The majority of participants were males (69.9%) and aged above 60 years. Gangrene was the leading cause of amputation, and 71% experienced phantom limb pain. Minimal depression was most common, followed by mild and moderate depression. Duration since amputation showed a significant association with depression severity (p=0.047), with higher depressive symptoms observed in the early post-amputation period. Return to employment demonstrated a highly significant protective association (p=0.001). Sleep dissatisfaction was also significantly associated with higher depression levels (p=0.009). Phantom limb pain and prosthetic limb use did not show statistically significant associations.

Conclusion: Depression among amputees is influenced by psychosocial reintegration and functional factors rather than prosthetic use alone. Vocational rehabilitation, sleep management, and long-term psychosocial support play critical roles in improving mental health outcomes. Integrating psychological screening into routine amputee rehabilitation services is essential for holistic care